Department of Geriatric Psychiatry, Klinikum Christophsbad, Faurndauer Str. 6-28, 73035, Göppingen, Germany.
Department of Radiology and Neuroradiology, Klinikum Christophsbad, Göppingen, Germany.
J Neural Transm (Vienna). 2021 Dec;128(12):1813-1833. doi: 10.1007/s00702-021-02426-9. Epub 2021 Oct 7.
The emergence of new artistic activities or shifts in artistic style in patients with frontotemporal dementia (FTD) syndromes is well documented at or after disease onset. However, a closer look in the literature reveals emerging artistic creativity also before FTD onset, although the significance and underlying pathology of such creative endeavors remain elusive. Here, we systematically review relevant studies and report an additional FTD case to elaborate on artistic activities that developed years before disease manifestation by paying particular attention to the sequence of events in individual patients' biography and clinical history. We further discuss the FTD patient's creative activities in the context of their life events, other initial or "premorbid" dementia symptoms or risk factors described in the literature such as mental illness and mild behavioral impairment (MBI), as well as changes in neuronal systems (i.e., neuroimaging and neuropathology). In addition to our FTD patient, we identified five published cases with an FTD syndrome, including three with FTD, one with primary progressive aphasia (PPA), and one with the behavioral variant of PPA (bvPPA). Premorbid novel creativity emerged across different domains (visual, musical, writing), with the FTD diagnosis ensuing artistic productivity by a median of 8 years. Data on late-life and pre-dementia life events were available in four cases. The late creative phase in our case was accompanied by personality changes, accentuation of personality traits, and cessation of painting activities occurred with the onset of memory complaints. Thus, premorbid personality changes in FTD patients can be associated with de novo creative activity. Stressful life events may also contribute to the burgeoning of creativity. Moreover, primary neocortical areas that are largely spared by pathology at early FTD stages may facilitate the engagement in artistic activities, offering a window of opportunity for art therapy and other therapeutic interventions during the MBI stage or even earlier.
额颞叶痴呆（FTD）综合征患者在疾病发病前后出现新的艺术活动或艺术风格转变已有充分记载。然而，仔细研究文献可以发现，在 FTD 发病前也会出现新兴的艺术创造力，尽管这些创造性努力的意义和潜在病理学仍然难以捉摸。在这里，我们系统地回顾了相关研究，并报告了另外一个 FTD 病例，详细阐述了在疾病表现之前多年就开始的艺术活动，特别关注患者个人传记和临床病史中的事件顺序。我们进一步讨论了 FTD 患者的创造性活动，将其置于他们的生活事件、文献中描述的其他初始或“前驱”痴呆症状或危险因素（如精神疾病和轻度行为障碍（MBI））以及神经元系统变化（即神经影像学和神经病理学）的背景下。除了我们的 FTD 患者外，我们还确定了五例具有 FTD 综合征的已发表病例，包括三例 FTD、一例原发性进行性失语症（PPA）和一例行为变异型 PPA（bvPPA）。前驱性新颖创造力出现在不同领域（视觉、音乐、写作），中位 FTD 诊断时间为 8 年。在四个病例中，可获得晚期和痴呆前的生活事件数据。我们病例中的晚期创作阶段伴随着人格变化、人格特征的强调以及绘画活动的停止，同时出现了记忆主诉。因此，FTD 患者前驱期的人格变化可能与新的创造性活动有关。生活中的应激事件也可能促成创造力的涌现。此外，在早期 FTD 阶段，主要的新皮质区域受到的病理影响较小，这可能有助于患者参与艺术活动，为艺术治疗和其他治疗干预提供机会，即使在 MBI 阶段或更早阶段。
